Systems, methods and apparatus are provided through which in some aspects a custom orthopedic implant is designed, fabricated and sterilized for immediate surgical use to treat a patient's injury. In some aspects, the orthopedic implant is designed using patient and injury specific scan data, fabricated using a five axis milling machine, and sterilized with a sterilization system. In other aspects, the fabricated orthopedic implant is transferred into the sterilization system with a transport system. In some aspects, methods to design, fabricate and sterilize a custom orthopedic implant are presented. In other aspects, patient and injury specific scan data is used to design and plan the placement of a custom orthopedic implant to treat the injury, and the custom orthopedic implant is then fabricated and sterilized to be used in surgery.